PDF(Pubmed)
Abstract：
To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.
摘要：
比较糖尿病视网膜病变（DR）的两种筛查策略，并确定在常规DR筛查中包括光学相干断层扫描（OCT）的健康经济影响。这项横断面研究包括来自奥斯陆大学医院试点DR筛查计划的1型或2型糖尿病（T1D或T2D）患者队列（≥18岁），挪威。除对所有患者进行眼底照相外，还进行OCT的联合筛查策略，在该队列中进行，并与我们现有的序贯筛查策略进行比较。在顺序筛查策略中，仅在眼底照相显示糖尿病性黄斑水肿（DME）的情况下，在另一天进行OCT。由两名医学视网膜专家确定眼底照相上糖尿病性黄斑病变和OCT上DME的存在。根据飞行员糖尿病黄斑病变和DME的患病率，我们确定了两种筛查策略对健康-经济的影响.该研究包括90例患者的180只眼。18例患者的27只眼患有糖尿病性黄斑病变，其中，6例患者的7只眼在OCT上显示DME。当眼底照片上没有糖尿病性黄斑病变时，OCT无法显示DME。因此，18例（20%）糖尿病性黄斑病变患者需要在序贯筛查策略中进行OCT额外检查，其中6人（33%）在OCT上有DME。在扩展的医疗保健视角分析中，序贯筛查策略的成本高于联合筛查策略的成本.眼底照相上的糖尿病性黄斑病变与OCT上的DME之间存在弱关联。健康经济分析表明，将OCT作为DR筛查的标准测试可能会节省成本。
